First and Last Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Gender
*
Male
Female
Are you over the age of 18
*
Yes
No
Which service are you enquiring about? *
*
Eyebrow Tattooing
Lip Tattooing
Tattoo Removal
Are you currently using any medication?
*
Yes
No
Are you able to use topical anaesthetics? (lignocaine, tetracaine, prilocaine, epinephrine)
*
Yes
No
Are you pregnant, planning pregnancy or breastfeeding?
*
Yes
No
Do you have oily skin?
*
Yes
No
Have you had the area tattooed before?
*
Yes
No
Do you have health concerns?
*
Yes
No
Are you iron deficient or anaemic?
*
Yes
No
Do you suffer from keloid (raised) scarring?
*
Yes
No
Have you ever had a cold sore?
*
Yes
No
Do you suffer from anxiety/depression?
*
Yes
No
Please send some clear photos of the area you are enquiring about (natural lighting, no filters or makeup, back camera on phone (not the selfie camera)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional Information (if you answered yes to any of the above please provide details as well as what you are hoping to achieve):
How would you prefer to be contacted?
Email
SMS
Phone Call
Submit
Should be Empty: